Provider Demographics
NPI:1104094143
Name:THREE RIVERS EYE CARE, PS
Entity type:Organization
Organization Name:THREE RIVERS EYE CARE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAULAINEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-414-8000
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-0102
Mailing Address - Country:US
Mailing Address - Phone:360-414-8000
Mailing Address - Fax:360-414-1100
Practice Address - Street 1:209 WEST MAIN ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-4456
Practice Address - Country:US
Practice Address - Phone:360-414-8000
Practice Address - Fax:360-414-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1162400001Medicare NSC